Examination Support - Additional Resources and References

ADDITIONAL RESOURCES AND REFERENCES

Improving memory skills

What is memory?

Memory is the term given to the structures and processes involved in the storage and subsequent retrieval of information. It is the means by which we draw on our past experiences in order to use this information in the present’ (Sternberg, 1999).

Memory is essential to our lives. We could not learn anything without the recall of previous experiences, we could not function in the present nor plan for the future.

It involves three aspects: 1) encoding, the reprocessing of information into a variety of forms including visual, auditory, kinaesthetic, and semantic to facilitate storage; 2) storage of this information; 3) its retrieval.

There are many models of memory most include the elements of a sensory register/ short term memory, a working memory, and the long-term storage system –the information is transferred from one store to another- see the illustration below.

The sensory register / short term memory receives the information from the senses -this is then transferred to the working memory which is the system that holds on to information long enough for it to be processed and transferred into long term memory.

There has been a huge amount of research into, and some controversy about the working memory system as it is said to underpin the learning process but most researchers agree that it has limited capacity, that means if this is overloaded i.e. then information is forgotten, however strategy development and interacting with long term memory are the solutions to this e.g. question it, organise it, make it meaningful and see below.

For more explanation see ‘How your "working memory" makes sense of the world' (Peter Doolittle | TEDGlobal 2013) (click the text to view the TedTalk)

The long-term memory is a relatively permanent store of unlimited capacity. This storage system is divided into several categories. Explicit / declarative memory is the intentional recollection of factual information previous experiences and concepts. This memory store is further divided into two categories episodic memory, those memories of personal experience or in this context clinical experience and semantic memory the understanding of concepts. Implicit memory is the internalised memory that are largely unconscious, learning is not necessarily deliberate, and retrieval can be automatic. Procedural memory is a subset of implicit memory, the learning of procedures such as driving a car, playing the piano, even writing your name.

General principles of memory improvement.

Most people do not have trouble storing information they have learned. Retrieval is more difficult. Improvement is just about the development of strategies that facilitate recall. Having good strategies does not mean having a bigger memory. There are many approaches but there are several major principles that should be considered. The most important are:

Memory strategies serve different purposes – it is important therefore to ensure the one suggested suit the task.
Good memory strategies need to be individualised/ personalised.
The effectiveness of memory strategies can be determined by an individual’s knowledge base. The best ones come from an individual’s experience.
Strategy development must operate on the law of parsimony – people only need the strategies they need. Good strategies should consume as few intellectual processes as is necessary.
There are many books on memory improvement, some better than others. They should only be used as a recipe book from which you can select the ones that suit you.
Memory strategies that can help with both storage and retrieval involve similar elements: repetition, multisensory input, the use of logic and links, relying on imagery, frequency, working for short periods of time.

Type of Memory Strategy

The following are types of strategy commonly used.

Categorical information: this is where information such as pictures ccompanying a category are used or items are analysed into smaller units through association.
Elaboration: this involves assigning meaning by using a phrase or sentence, analogy or drawing relationship based on specific characteristics.
General aids: these are designed and used to serve a general reference purpose and can include dictionaries or other reference works.
Imagery: this involves the use of mental pictures.
Metamemory: this involves developing an understanding of the nature and limits of memory, considering factors which will facilitate remembering.
Orienting attention: this is a question of directing one’s attention using prompts such as ‘this is important’.
Rehearsal: including verbal rehearsal or writing over material.
Specific aids: for problem solving and memorising, including concrete materials
Specific attention aids: using objects, language, or parts of their body to maintain orientation to a task
Transformation: is a strategy suggested for converting difficult problems into simpler ones than can be remembered more easily.

Remember the revision / learning process must go beyond reading and memorizing facts and information and lead to being able to critically evaluate the information, retrieve it when necessary to answer questions or to explain it to others in oral examinations, and indeed, use it in a clinical setting.

A Planning Strategy from 'Revision' section

Look at the curriculum, evaluate your knowledge base, ask What are my areas of strength? What needs to be covered?
Identify areas that need to be learned: level of difficulty, interest, and type of information
Break the work into manageable chunks. How can you make studying the topic multisensory and interactive? Try and determine the task specific method, e.g. is it a process? Therefore, create a flowchart. Does it have to be rote learned, if so, do it little and often. Find a variety of ways.
Estimate how long it might take. Set goals. Be realistic. Put in a weekly / monthly diary or outlook calendar. Working for 30-minute periods with mini break is deemed to be the most productive.
Predict any barriers to keeping the plan- put in a blank afternoon to catch up.
Implement your strategy
Check how you are getting on – change something if attention is waning
Reflect and evaluate each learning session. Date and tick off the work when done and move on. Do not dwell on what was not achieved- try to plan to revisit it or move on.
Focus and celebrate on what you have learned/ achieved
Consider if working with others and setting goals with your supervisor help keep you on track
Ensure to build in enough rest and relaxation – the brain needs time to consolidate what you have learned
Change it – review it – update it -if the plan is not working, make it more realistic or flexible or even ditch it. It is a tool to give you confidence, not undermine you.

ACTIVITY 6

Look at the scenario below taken from the AKT -

A 70-year-old man is seen for follow up. He was seen by a colleague almost four weeks ago complaining of a hoarse voice and you can see from the notes that a viral infection was diagnosed, and symptomatic advice issued. He has returned to see you as there has not been any improvement in his symptoms. His voice continues to be hoarse and this is evident on speaking to him. He gave up smoking over 20 years ago and is only an occasional drinker. There is no cough. He says that he has not had any coryzal symptoms or other acute unwellness recently. His weight is stable. He has not coughed up any blood. Ear, nose and throat examination with a handheld scope and clinical chest examination are both normal.

What is the most appropriate management strategy?

This information can be deconstructed to make it more manageable- colour coding can help locate the information - as illustrated below

As suggested previously:

Find the question sentence first and highlight it.
Take each sentence at a time – What is the main idea or key information in it. How does it link to the next sentence. The colour coding below shows how the information can be separated out.

The key at the end will give you the clues.

What is the most appropriate management strategy?

Key:

Age and gender of a patient are nearly always in the first sentence
Initial meeting symptoms of 4 weeks ago
Present symptoms
Examination conducted

Now what do you think the answer is?

Look to see if your answer is written below:

Arrange testing for pertussis
Prescribe a course of oral antibiotics and advise review if symptoms persist post-treatment
Prescribe a nasal steroid and arrange to review him in six to eight weeks
Refer urgently to a respiratory physician
Refer urgently to an ear, nose and throat specialist

Having selected the answer (the last one is the correct one here) go back and verify your choice. Find the evidence for your decision i.e. differential diagnosis.

Then go back and consider why the others were wrong and when would they have been the right answer.

Additional materials and resources

References

Dale, E. (1969) Audio-visual Methods in Teaching, NY: Dryden Press

Mcloughlin, D and Leather, C. (2013) The adult dyslexic: Interventions and outcomes – an evidence-based approach (2nd ed.). Chichester: John Wiley & Sons, Ltd.

Richmond, A., Cranfield, T. and Cooper, N. (2019) Study tips for medical students. BMJ : British Medical Journal (Online); Vol. 365, ). DOI:10.1136/bmj. k663

Sousa, D. A (2016). How the Brain Works. Crowin Press. 2016.

Boniwell, I. (2008). Positive psychology in a nutshell: A balanced introduction to the science of optimal functioning. Personal Well-Being Centre.

Suggested readings on learning theory

Bloom, B. S., Engelhart, M. D., Furst, E. J., Hill, W. H., Krathwohl, D. R. (1956). Taxonomy of educational objectives: The classification of educational goals. Handbook I: Cognitive domain. New York: David McKay Company.

Clark, J. (2005) Explaining Learning: From analysis to paralysis to hippocampus. Educational Philosophy and Theory, 37 (5), 667-687

Illeris, K. (ed) (2018) Contemporary Theories of Learning: Learning theorists in their own words. Second edition. London: Routledge

Illeris, K. (2002) The Three Dimensions of Learning: Contemporary Learning Theory in the Tension Field between the Cognitive, the Emotional and the Social. Frederiksberg. Denmark: Roskilde University Press.

Jarvis, P. (2004) Adult Education and Lifelong Learning (3rd edition), Chapter 1, page 1-38. London: Routledge.

Kaufman, D. and Mann, K. (2006) Teaching and Learning in Medical Education: how Theory can inform practice. Understanding Medical Education occasional paper. Edinburgh: ASME.

Kinchin, I., Baysan, A. and Cabor, B. L. (2008) Towards a pedagogy for clinical education: beyond individual learning differences. Journal of Further and Higher Education 32 (4), 373-387.

Kost, M. A. and Chen, M. F (2015) Socrates Was Not a Pimp: Changing the Paradigm of Questioning in Medical Education. Academic Medicine, Vol.90(1), pp.20-24

Rogers, C. (1969). Freedom to Learn: A View of What Education Might Become. (1st ed.) Columbus, Ohio: Charles Merill.

Sousa, D. A. (2011). How the brain learns (4th ed.). Thousand Oaks: Corwin Press

Wolff, M., Wagner, M. J., Poznanski, S., Schiller, J. and Santen, S. (2015) Not Another Boring Lecture: Engaging Learners with Active Learning Techniques. Journal of Emergency Medicine, Vol.48(1), pp.85-93

Example exam questions

There are a variety of examination question banks and revision courses commonly used including:

MRSC/FRSA/MRCP/MRCGP

Additional resources for MRCGP